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Department Of Orthodontics And Dentofacial Orthopaedics
A.B.Shetty Memorial Institute Of Dental Sciences

SOFT TISSUE CEPH...
LEONARDO DA VINCI

www.indiandentalacademy.com

(16 th century )
DURER In his book
FOUR BOOKS OF
FACIAL
PROPORTIONS Used
Geometric methods to
study the face .
He provided
proportionate an...
CAMPER

(18 th century)

www.indiandentalacademy.com
www.indiandentalacademy.com
EDMOND H WUERPEL - “ A face is beautiful and
shows harmonious features if the proportions of
its individual components are...
SOFT TISSUE CEPHALOMETRIC LANDMARKS

SOFT TISSUE NASION

PRONASALE
SUB NASALE
SUB SPINALE
LABRALE SUPERIUS
STOMION
LABRALE...
PROFILE

ANALYSIS

PROPORTIONAL ANALYSIS
Ideal profile provides a basic standard for
assessment of average profile
Ideal p...
ANGULAR PROFILE ANALYSIS SUBTENLY )
(

•

Subtently makes a distinction between skeletal soft tissue and full soft tissue
...
SUBTENLYS PROFILE THICKNESS ANALYSIS

Soft tissue thickness at the Glabella remains constant
Thickness of Sulcus Labrale S...
BOWKER AND MEREDITH STUDIES ON SOFT TISSUE THICKNESS

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PROFILE ANALYSIS BY A.M. SCHWARZ (1929)

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GNATHIC PROFILE FIELD

TANGENT T - Sn – Pog

T ANGLE OR PROFILE ANGLE

AVG -10 DEGREES

Tan T

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AVERAGE FACE - Sn on Pn
RETRO FACE
behind Pn

- Sn

ANTE FACE - Sn ahead
of Pn

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STRAIGHT ANTE FACE
- Displacement of Pog
with Sn anteriorly
- GPF parallel and
anterior to
average face
STRAIGHT RETRO FAC...
OBLIQUE RETRO FACE – Posterior rotation of avg face. Maxilla
positioned posteriorly and mandible even more posteriorly
AVE...
OBLIQUE ANTE FACE- Forward rotation of average face, Maxilla is
anterior and mandible even more anterior.
AVERAGE FACE , G...
CLASS II MALOCCLUSION

AVG FACE

RETRO FACE

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ANTE FACE
CLASS III MALOCCLUSION

AVE FACE

RETRO FACE

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ANTE FACE
ANALYSIS OF THE LIPS

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LENGTH OF UPPER LIP
MEAN VALUES
BURSTONE
Boys - 24 mm
Girls - 20 mm
RAKOSI
Boys - 22.5 mm
Girls - 20 mm
CLASS – II

22

mm...
LENGTH OF LOWER LIP
MEAN VALUES
BURSTONE - Boys- 50 .0 mm
Girls- 46.5 mm
RAKOSI -

Boys- 45.5 mm
Girls- 40.0 mm

CLASS II ...
THICKNESS OF RED PART OF UPPER LIP
AVERAGE SIZE
11.5 mm ( RAKOSI)
CLASS II : Upper lip thin due
to angulation of
upper inc...
THICKNESS OF RED PART OF LOWER LIP
AVERAGE SIZE
12.5 mm ( RAKOSI )
CLASS II : Lower lip
is thicker ( 14 mm )
CLASS III : L...
STEINERS LIP ANALYSIS
Reference point is the
Centre of the S SHAPED
CURVE between the tip of
Nose and Sub Nasale
Reference...
RICKETTS LIP ANALYSIS

Reference line connects
NOSE TIP TO SOFT TISSUE
POGONION - E LINE
Lips are analysed
E Line dependin...
HOLDAWAYS ANALYSIS
( 1983 )

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FACIAL ANGLE AND UPPER LIP CURVATURE
FACIAL ANGLE is formed by the
intersection of FH PLANE
with line joining N TO POG
AVG...
H- LINE ANGLE AND SKELETAL CONVEXITY AT POINT A
H line angle formed between
H-line and Line Joining N to
Pog
Avg Value- 7-...
RELATIONSHIP BETWEEN H-LINE AND SKELETAL CONVEXITY
AT POINT A

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NOSE TIP TO H-LINE AND UPPER SULCUS DEPTH
NOSE TIP TO H-LINE
AVG VALUE – 12 mm MAX

UPPER SULCUS DEPTH
MEASURED FROM SUB
S...
UPPER LIP THICKNESS AND UPPER LIP STRAIN
Upper lip thickness is measured
horizontally from a point 2 mm
below point a to o...
LOWER SULCUS DEPTH AND SOFT TISSUE CHIN THICKNESS
Lower sulcus depth is
measured from the deepest
point in the curvature
b...
ACCORDING TO HOLDAWAY
A PERFECT PROFILE SHOULD
HAVE
ANB - 2 degrees
H-LINE ANGLE -7 to 8 degrees
LOWER LIP should touch th...
ANALYSIS OF TONGUE
POSITION

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THREE REFERENCE POINTS
ARE USED

I – INCISAL EDGE OF LOWER
INCISORS

Mc – DISTAL AND CERVICAL
THIRD OF LAST ERUPTED
MOLAR
...
ASSESSMENT OF TONGUE POSITION
.
1Represents distance between soft palate and tongue
2 – 6 Represents distance between dors...
ANALYSIS FOR
ORTHOGNATHIC SURGERY
BY HARRY LEGAN AND CHARLES BURSTONE

www.indiandentalacademy.com
HORIZONTAL
PLANE

COLUMELLA

GNATHION
CERVICAL
POINT

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ANGLE OF FACIAL CONVEXITY

G TO Sn , Sn TO Pog
MEAN VALUE - 12 DEGREES
POSITIVE VALUE – CLASS II
NEGATIVE VALUE - CLASS II...
LOWER FACE THROAT ANGLE
Sn to Gn , Gn to C
MEAN VALUE – 100 DEGREES
DECREASE IN VALUE INDICATES
PROMINENT CHIN

www.indian...
ANTERO POSTERIOR MAXILLARY AND MANDIBULAR
MEASUREMENTS , mean value 6 mm
VERTICAL FACIAL HEIGHT PROPORTIONALITY
www.indian...
UPPER AND LOWER LIP
PROTRUSION
Mean Values
Ls – Sn Pog

3 mm
Sn

Li – Sn Pog

2 mm

Ls
Li

Pog

www.indiandentalacademy.co...
MENTO LABIAL SULCUS

Mean Value- 4 mm

Li
Sm
Pog

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NASOLABIAL ANGLE

Mean Value - 102

O

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VERTICAL LIP CHIN RATIO
Mean Value - 1:2
INTER LABIAL GAP
Mean Value - 2 mm
MAXILLARY INCISOR
EXPOSURE
Mean Value - 2 mm

...
CONCLUSION
Soft tissue changes during the course of treatment
should be considered.
Method of treatment chosen or modified...
THOMAS AQUINAS FUNDAMENTAL TRUTH OF ESTHETICS

“ THE SENSES DELIGHT IN THINGS DULY
PROPORTIONED ”

www.indiandentalacademy...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Soft tissue cephalometric analysis /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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0091-9248678078

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Soft tissue cephalometric analysis /certified fixed orthodontic courses by Indian dental academy

  1. 1. Department Of Orthodontics And Dentofacial Orthopaedics A.B.Shetty Memorial Institute Of Dental Sciences SOFT TISSUE CEPHALOMETRIC ANALYSIS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. LEONARDO DA VINCI www.indiandentalacademy.com (16 th century )
  3. 3. DURER In his book FOUR BOOKS OF FACIAL PROPORTIONS Used Geometric methods to study the face . He provided proportionate analysis of Leptoproscopic (long ) face and Euryproscopic (short) face . www.indiandentalacademy.com
  4. 4. CAMPER (18 th century) www.indiandentalacademy.com
  5. 5. www.indiandentalacademy.com
  6. 6. EDMOND H WUERPEL - “ A face is beautiful and shows harmonious features if the proportions of its individual components are right ” CALVIN CASE - “ A balanced profile should be one of the key factors in deciding the method of treatment for any form of malocclusion ” www.indiandentalacademy.com
  7. 7. SOFT TISSUE CEPHALOMETRIC LANDMARKS SOFT TISSUE NASION PRONASALE SUB NASALE SUB SPINALE LABRALE SUPERIUS STOMION LABRALE INFERIUS SUB MENTALE SOFT TISSUE POGONION SKIN GNATHION www.indiandentalacademy.com
  8. 8. PROFILE ANALYSIS PROPORTIONAL ANALYSIS Ideal profile provides a basic standard for assessment of average profile Ideal profile ; Can be divided into three equal parts Frontal Third ( Tr- N ) Nasal Third (N - Sn ) Gnathic Third ( Sn – Gn ) ANTERIOR FACE CAN BE PROPORTIONED ( N – Gn ) Midface - N To Sn - 45% Lower Face – Sn To Gn -55% www.indiandentalacademy.com
  9. 9. ANGULAR PROFILE ANALYSIS SUBTENLY ) ( • Subtently makes a distinction between skeletal soft tissue and full soft tissue (including nose) O SKELETAL PROFILE ( N- POINT A - Pog ) AVG VALUE - 175 Convexity decreases with age as skeletal form straightens with age. I I b) SOFT TISSUE PROFILE ( N – Sn – Pog ) AVG VALUE – 161 Convexity does not change with age I I O O O c) FULL SOFT TISSUE ( N – No – Pog ) AVG VALUE -137 (M) & 133 (F) Convexity increases with age because of anterior growth of the nose. Soft tissue changes are not analoges to skeletal profile changes. www.indiandentalacademy.com
  10. 10. SUBTENLYS PROFILE THICKNESS ANALYSIS Soft tissue thickness at the Glabella remains constant Thickness of Sulcus Labrale Superius increases by approximately 5 mm Thickness of Sulcus Labrale Inferius increases by approximately 2 mm According to Subtenly there is a greater increase in maxillary than the mandibular soft tissue profile which explains why the soft tissue grows more convex with age www.indiandentalacademy.com
  11. 11. BOWKER AND MEREDITH STUDIES ON SOFT TISSUE THICKNESS www.indiandentalacademy.com
  12. 12. PROFILE ANALYSIS BY A.M. SCHWARZ (1929) www.indiandentalacademy.com
  13. 13. GNATHIC PROFILE FIELD TANGENT T - Sn – Pog T ANGLE OR PROFILE ANGLE AVG -10 DEGREES Tan T www.indiandentalacademy.com
  14. 14. AVERAGE FACE - Sn on Pn RETRO FACE behind Pn - Sn ANTE FACE - Sn ahead of Pn www.indiandentalacademy.com
  15. 15. STRAIGHT ANTE FACE - Displacement of Pog with Sn anteriorly - GPF parallel and anterior to average face STRAIGHT RETRO FACE - Displacement of Pog with Sn posteriorly - GPF parallel and posterior to average face www.indiandentalacademy.com
  16. 16. OBLIQUE RETRO FACE – Posterior rotation of avg face. Maxilla positioned posteriorly and mandible even more posteriorly AVERAGE FACE ,GNATHIC PROFILE SLANTING BACKWARDS - Backward rotation of the profile is partly compensated by forward displacement of Midface, therefore Sn avg position RETROFACE GNATHIC PROFILE SLANTING BACKWARD- Combined effect of backward rotation and marked forward displacement of the midface www.indiandentalacademy.com
  17. 17. OBLIQUE ANTE FACE- Forward rotation of average face, Maxilla is anterior and mandible even more anterior. AVERAGE FACE , GNATHIC PROFILE SLANTING FORWARD – Forward rotation of profile is compensated by backward displacement of the midface, Sn in average position RETROFACE , GNATHIC PROFILE SLANTING FORWARD – Combined effect of forward rotation and marked backward displacement of Midface www.indiandentalacademy.com
  18. 18. CLASS II MALOCCLUSION AVG FACE RETRO FACE www.indiandentalacademy.com ANTE FACE
  19. 19. CLASS III MALOCCLUSION AVE FACE RETRO FACE www.indiandentalacademy.com ANTE FACE
  20. 20. ANALYSIS OF THE LIPS www.indiandentalacademy.com
  21. 21. LENGTH OF UPPER LIP MEAN VALUES BURSTONE Boys - 24 mm Girls - 20 mm RAKOSI Boys - 22.5 mm Girls - 20 mm CLASS – II 22 mm CLASS – III 20.9 mm www.indiandentalacademy.com
  22. 22. LENGTH OF LOWER LIP MEAN VALUES BURSTONE - Boys- 50 .0 mm Girls- 46.5 mm RAKOSI - Boys- 45.5 mm Girls- 40.0 mm CLASS II - Retraction of upper incisors - lower lip curls up and moves forward CLASS III - Lingual tip of lower Incisors - lip moves backward www.indiandentalacademy.com
  23. 23. THICKNESS OF RED PART OF UPPER LIP AVERAGE SIZE 11.5 mm ( RAKOSI) CLASS II : Upper lip thin due to angulation of upper incisors CLASS III : Upper lip thicker as It rests on lower lip DURING COURSE OF Rx: CLASS II : Lip grows thicker CLASS III : Lip grows thinner www.indiandentalacademy.com
  24. 24. THICKNESS OF RED PART OF LOWER LIP AVERAGE SIZE 12.5 mm ( RAKOSI ) CLASS II : Lower lip is thicker ( 14 mm ) CLASS III : Lower lip is thinner ( 11.9 mm ) DURING COURSE OF Rx: CLASS II : Lower lip becomes thinner CLASS III : Lower lip becomes thicker www.indiandentalacademy.com
  25. 25. STEINERS LIP ANALYSIS Reference point is the Centre of the S SHAPED CURVE between the tip of Nose and Sub Nasale Reference line extends from this point to the SOFT TISSUE POGONION Lips behind this point are said to be flat (RETRUSIVE) Lips ahead of this line are said to be too prominent ( PROTRUSIVE) www.indiandentalacademy.com
  26. 26. RICKETTS LIP ANALYSIS Reference line connects NOSE TIP TO SOFT TISSUE POGONION - E LINE Lips are analysed E Line depending on the distance E of the lips from this line NORMAL VALUES UPPER : 2-3 mm LOWER : 1-2 mm www.indiandentalacademy.com
  27. 27. HOLDAWAYS ANALYSIS ( 1983 ) www.indiandentalacademy.com
  28. 28. FACIAL ANGLE AND UPPER LIP CURVATURE FACIAL ANGLE is formed by the intersection of FH PLANE with line joining N TO POG AVG VALUE -90 -92 DEGREES Greater angle - Protrusive lower jaw Lesser angle - Retrusive lower jaw UPPER LIP CURVATURE Reference line is drawn tangent from FH PLANE TO TIP OF UPPER LIP. Depth of upper sulcus is measured. AVG VALUE – 1.5 – 4.0 mm www.indiandentalacademy.com
  29. 29. H- LINE ANGLE AND SKELETAL CONVEXITY AT POINT A H line angle formed between H-line and Line Joining N to Pog Avg Value- 7- 15 Degrees Measures upper lip prominence or retrognathism of the Soft tissue chin Skeletal convexity at point a is measured from N-pog Line to Point A AVG VALUE - +2 TO -2 mm Assess facial skeletal Convexity relating to lip Position www.indiandentalacademy.com
  30. 30. RELATIONSHIP BETWEEN H-LINE AND SKELETAL CONVEXITY AT POINT A www.indiandentalacademy.com
  31. 31. NOSE TIP TO H-LINE AND UPPER SULCUS DEPTH NOSE TIP TO H-LINE AVG VALUE – 12 mm MAX UPPER SULCUS DEPTH MEASURED FROM SUB SPINALE TO H-LINE AVG VALUE- 5 mm www.indiandentalacademy.com
  32. 32. UPPER LIP THICKNESS AND UPPER LIP STRAIN Upper lip thickness is measured horizontally from a point 2 mm below point a to outer border of upper lip. AVG VALUE - 15 mm Upper lip strain is measured from vermillion border of the lip to the labial surface of the Max central incisor IF Upper lip thickness is greater than the upper lip strain then it indicates there Is strain in the Upper lip. www.indiandentalacademy.com
  33. 33. LOWER SULCUS DEPTH AND SOFT TISSUE CHIN THICKNESS Lower sulcus depth is measured from the deepest point in the curvature between the Lower lip and the chin and the h-line AVG VALUE- 5 mm Soft tissue thickness is measured from hard tissue Pogonion to soft tissue Pogonion. AVG VALUE- 10 TO 12 mm www.indiandentalacademy.com
  34. 34. ACCORDING TO HOLDAWAY A PERFECT PROFILE SHOULD HAVE ANB - 2 degrees H-LINE ANGLE -7 to 8 degrees LOWER LIP should touch the H line H-LINE should bisect S curve between Pronasale and Subnasale TIP OF THE NOSE - Should be 9mm anterior to h-line there should be no lip strain factor ( Upper Lip Strain =Upper Lip Thickness ) www.indiandentalacademy.com
  35. 35. ANALYSIS OF TONGUE POSITION www.indiandentalacademy.com
  36. 36. THREE REFERENCE POINTS ARE USED I – INCISAL EDGE OF LOWER INCISORS Mc – DISTAL AND CERVICAL THIRD OF LAST ERUPTED MOLAR V – MOST CAUDAL POINT ON THE SHADOW OF SOFT PALATE IV LINE IS BISECTED AT POINT O WHICH IS THE MIDPOINT www.indiandentalacademy.com
  37. 37. ASSESSMENT OF TONGUE POSITION . 1Represents distance between soft palate and tongue 2 – 6 Represents distance between dorsum of tongue and roof of mouth 3- Represents distance between tongue and incisors MOBILITY OF THE TONGUE - Position of tongue in occlusion is compared with that in rest position. Occlusal position is taken zero. +VE - HIGHER IN REST POSITION -VE - LOWER IN REST POSITION www.indiandentalacademy.com
  38. 38. ANALYSIS FOR ORTHOGNATHIC SURGERY BY HARRY LEGAN AND CHARLES BURSTONE www.indiandentalacademy.com
  39. 39. HORIZONTAL PLANE COLUMELLA GNATHION CERVICAL POINT www.indiandentalacademy.com
  40. 40. ANGLE OF FACIAL CONVEXITY G TO Sn , Sn TO Pog MEAN VALUE - 12 DEGREES POSITIVE VALUE – CLASS II NEGATIVE VALUE - CLASS III www.indiandentalacademy.com
  41. 41. LOWER FACE THROAT ANGLE Sn to Gn , Gn to C MEAN VALUE – 100 DEGREES DECREASE IN VALUE INDICATES PROMINENT CHIN www.indiandentalacademy.com
  42. 42. ANTERO POSTERIOR MAXILLARY AND MANDIBULAR MEASUREMENTS , mean value 6 mm VERTICAL FACIAL HEIGHT PROPORTIONALITY www.indiandentalacademy.com
  43. 43. UPPER AND LOWER LIP PROTRUSION Mean Values Ls – Sn Pog 3 mm Sn Li – Sn Pog 2 mm Ls Li Pog www.indiandentalacademy.com
  44. 44. MENTO LABIAL SULCUS Mean Value- 4 mm Li Sm Pog www.indiandentalacademy.com
  45. 45. NASOLABIAL ANGLE Mean Value - 102 O www.indiandentalacademy.com
  46. 46. VERTICAL LIP CHIN RATIO Mean Value - 1:2 INTER LABIAL GAP Mean Value - 2 mm MAXILLARY INCISOR EXPOSURE Mean Value - 2 mm www.indiandentalacademy.com
  47. 47. CONCLUSION Soft tissue changes during the course of treatment should be considered. Method of treatment chosen or modified to improve or atleast not compromise the patient profile. Possible variations in soft tissue profile should be discussed with the patients and consent obtained for treatment if undesirable changes are anticipated www.indiandentalacademy.com
  48. 48. THOMAS AQUINAS FUNDAMENTAL TRUTH OF ESTHETICS “ THE SENSES DELIGHT IN THINGS DULY PROPORTIONED ” www.indiandentalacademy.com
  49. 49. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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